Ulnar Collateral Ligament Injury: Causes, Symptoms, and Treatment

Introduction

Ulnar collateral ligament injury is a common injury of the elbow that most commonly occurs during Sports. Excessive repeated movements result in the injury of the ulnar collateral ligament. These ligaments are strong tissue bands that provide strength and support to the joints. Stress-strain or rupture in the ligament results in pain, discomfort, tenderness, and restricted movements of joints. Treatment of ulnar collateral ligament injury includes surgical intervention and conservative treatments. Most of the cases are fully treatable.

What Is an Ulnar Collateral Ligament Injury?

Ulnar collateral injury is also known as a baseball pitcher's injury. It is a common injury to the inner side of the elbow and is commonly caused due to overuse of ligaments. A person suffering from an ulnar collateral ligament injury will emerge symptoms like pain and tenderness in the inner side of the elbow area. Sports people are commonly affected.

What Is the Ulnar Collateral Ligament?

The ulnar collateral ligament is a tissue band on the elbow's inner side that stabilizes the elbow joints during the overhead throw. Injury and overuse of ulnar collateral ligaments cause pain, swelling, tear, and stretch in the arms, which results in irritation and inflammation.

How Does the Ulnar Collateral Ligament Work?

Ulna, radius, and humerus are three bones that form the elbow joints. This joint is a hinge and pivot type of joint. This joint allows movement like straightening, rotation and twisting of arms. The ulnar collateral ligament is present on the inner side of the elbow and connected with bones (humerus and ulna). The connection between the joint and the UCL ligament is a strong band connection. Three strong band connections are present: anterior band connection, posterior band connection, and diagonal band connection. The Anterior band is very important because it helps in the stability of the elbow.

What Is the Classification of Ulnar Collateral Ligament Injury?

Injury of stretching of the ulnar collateral ligament can result in three types of injury, which are listed below -

• Mild or Grade 1 - Very mild stretching can be seen in the ligaments. Mildly painful and can be treated with conservative treatment.

• Moderate or Grade 2 - Moderate stretching of ligaments present, and ligament tear may or may not be present. Severe pain in difficulty in movement present can be treated with conservative treatments.

• Severe or Grade 3 - Ligaments are completely torn, and severe stretching is present. Severe pain and restrictive movements can be seen. Surgical treatment is required in this case.

What Are the Symptoms of Ulnar Collateral Ligament Injury?

Symptoms of ulnar collateral ligament injuries are listed below -

• Pain on the inner side of the elbow while overhead throw.

• Pain in the elbow area after sports like baseball and javelin throw.

• Discomfort movement.

• Pain while the forward movement of arms.

• Difficult hand grips.

• The inability to throw fast or very hard.

• Sensation like tingling and numbness in the smallest finger of the hand.

What Are the Causes of Ulnar Collateral Ligament Injury?

The causes of ulnar collateral ligament injuries are listed below -

1. Repetitive Motion (Overhead Throwing) - Repetitive motion of arms during sports like baseball can result in a UCL injury.

2. Overuse Injuries - Sports like baseball or bowling during cricket require a lot of hand movement. These movements result in the overuse of ligaments which causes injuries to the ulnar collateral ligament. Athletes doing excessive training can also suffer ulnar collateral ligament injury. Years of strenuous exercise or training can cause torn ligaments. Sometimes these ligaments get completely detached from the bone, which results in severe pain, swelling, and inflammation of the UCI.

3. Trauma - Injury to the elbow or UCL ligament can also result in a UCL tear. Bad landings or falling on the elbows during sports also result in UCL injuries.

How to Diagnose an Ulnar Collateral Ligament Injury?

Diagnosis of ulnar collateral ligament injury is generally made by Orthopedic doctors or sports medicine specialists. The doctor will ask for -

1. History - The doctor will ask for medical and sports history during the examination. Any previous injury, surgery, or medical illness will be reviewed by the doctors.

2. Physical Examination - The doctor will perform a physical test to check the elbow's movement, tenderness, and pain. Muscle mass, stability, and strength will also check for a clear diagnosis of UCL.

3. Valgus Stress Test - Physical test includes a valgus stress test. In this test, The doctor will press the UCL of the patient and elevate the arm to 30 degrees; then, the doctor will move the patient's lower arm outward and elbow inwards. The result is positive if a loose elbow joint or pain is noticed.

4. CT Scan and X -Rays - Computed tomography and X-ray help diagnose ulnar collateral ligament injury. These tests provide clear images of bones and fractures. These are not helpful in soft tissue imaging.

5. MRI - Magnetic resonance imaging scan is helpful in soft tissue imaging. It will show fractures of ligaments and tendons and any micro tears in ligaments.

6. Arthrogram - It is basically used to check bone joints. A die is injected into the joints with the help of an injection, and an MRI is used to check for any problem which is hard to catch in a normal MRI or CT scan.

What Is the Treatment for Ulnar Collateral Ligament Injury?

Ulnar collateral ligament injury treatment includes conservative, physical, and surgical treatment.

Conservative Treatment - Conservative treatment of UCL injury is as follows -

• Rest - Conservative treatment's first priority is rest. In case of UCL injury, proper rest is important to relieve stress and overuse tension. Stop all the sports activities and rest for the advisable time from the specialist.

• Ice Application - application of ice over the injured area, helps relieve pain and swelling. Ice packs should be used two to three times a day. Do not apply ice directly to the injury; it can lead to ice burn. Use an ice pack or put ice cubes under a towel, then apply.

• Medication - Medicines like nonsteroidal anti-inflammatory drugs are helpful in reducing pain and swelling.

• Injection of PRP (Plasma-Rich Platelets) - Helpful in moderate UCL cases. Injection of platelets is given in the area of the elbow.

Surgical Treatments Include - Surgical treatments of ulnar collateral ligament injury are listed below -

• UCL Direct Repair - In case of a single injury that causes detachment of the UCL from the bone, UCL direct repair helps in the reattachment of the UCL ligament to the bone.

• UCL Reconstruction - It is also known as Tommy John Surgery. If in case of unstable or torn UCL, if conservative treatments are not helpful in relieving pain, or if athletes want to continue their sports, then UCL reconstruction is required. In this surgery, the surgeon takes a tendon from another part of the body or a donor site. And attaches it to the elbow joint to work as a UCL. This surgery will help with stability, range of motion, and elbow strength, and relieve pain.

Physical Treatment - Physical treatment provides stability and strength to elbow muscles and joints.

Conclusion

Ulnar collateral injury is caused due to excessive and repetitive injury. Sudden pain, tenderness, and swelling are present in the inner area of the elbow. UCL is common in athletes playing baseball, cricket, and javelin. Overuse of ligaments results in ligament tears causing severe pain or loosening of joints. Treatments of UCL include conservative and surgical treatments; most cases of UCL can be treated by conservative treatment only.